Schiavon Michele, Vella Adrian, Dalla Man Chiara
Department of Information Engineering, University of Padova, Padova, Italy.
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States.
Am J Physiol Endocrinol Metab. 2025 Aug 1;329(2):E354-E366. doi: 10.1152/ajpendo.00407.2024. Epub 2025 Jul 12.
Disposition index (DI), defined as the product of insulin sensitivity and β-cell responsivity, is the best measure of β-cell function. This is usually assessed from plasma glucose and insulin, and sometimes C-peptide, data either from surrogate indices or model-based methods. However, the recent advent of continuous glucose monitoring (CGM) systems in non-insulin-treated individuals raises the possibility of its quantification in outpatients. As a first step, we propose a method to assess DI from glucose concentration data only and validated it against the oral minimal model (OMM). To do so, we used data from two clinical dataset with mixed meal tolerance test (MTT) studies in non-insulin-treated individuals: the first consisted of 14 individuals with type 2 diabetes studied twice, either after receiving a DPP-4 inhibitor or a placebo before the meal, whereas the second consisted of 62 individuals with and without pre- or type 2 diabetes. A third, simulated, dataset consisted of 100 virtual subjects from the Padova Type 2 Diabetes Simulator was used for additional tests. Plasma glucose, insulin, and C-peptide concentrations were used to estimate the reference DI from the OMM (DI), whereas glucose data only were used to calculate the proposed DI (DI). DI was well correlated with DI in both the clinical and simulated datasets ( between 0.88 and 0.79, < 0.001), and exhibited the same between-visit or between-group pattern. DI can be used to assess therapy effectiveness and degree of glucose tolerance using glucose data only, paving the way to potentially assess β-cell function in real-life conditions using CGM. The advent of continuous glucose monitoring (CGM) in non-insulin-treated individuals raises the possibility of quantifying disposition index (DI), a key metric of β-cell function usually assessed in research settings, in outpatients. A method for DI estimation from postprandial glucose data only (DI) was developed and validated against a reference. DI can be used to assess therapy effectiveness and degree of glucose tolerance in non-insulin-treated individuals, paving the way for its quantification in real-life conditions from CGM devices.
处置指数（DI）定义为胰岛素敏感性与β细胞反应性的乘积，是衡量β细胞功能的最佳指标。这通常通过血浆葡萄糖和胰岛素，有时还包括C肽的数据来评估，这些数据可以来自替代指标或基于模型的方法。然而，非胰岛素治疗个体中连续血糖监测（CGM）系统的出现，提高了在门诊患者中对其进行量化的可能性。作为第一步，我们提出了一种仅根据葡萄糖浓度数据评估DI的方法，并针对口服最小模型（OMM）对其进行了验证。为此，我们使用了两个临床数据集的数据，这些数据集包含非胰岛素治疗个体的混合餐耐量试验（MTT）研究：第一个数据集由14名2型糖尿病患者组成，他们在餐前接受二肽基肽酶-4抑制剂或安慰剂治疗后进行了两次研究，而第二个数据集由62名有或无糖尿病前期或2型糖尿病的个体组成。第三个模拟数据集由来自帕多瓦2型糖尿病模拟器的100名虚拟受试者组成，用于额外的测试。血浆葡萄糖、胰岛素和C肽浓度用于根据OMM估计参考DI（DI），而仅使用葡萄糖数据来计算所提出的DI（DI）。在临床和模拟数据集中，DI与DI均具有良好的相关性（在0.88至0.79之间，<0.001），并且呈现出相同的就诊间或组间模式。DI可用于仅使用葡萄糖数据评估治疗效果和葡萄糖耐量程度，为使用CGM在实际生活条件下潜在评估β细胞功能铺平了道路。非胰岛素治疗个体中连续血糖监测（CGM）的出现，提高了在门诊患者中对处置指数（DI）进行量化的可能性，DI是通常在研究环境中评估的β细胞功能的关键指标。开发了一种仅根据餐后葡萄糖数据估计DI的方法（DI），并针对参考方法进行了验证。DI可用于评估非胰岛素治疗个体的治疗效果和葡萄糖耐量程度，为通过CGM设备在实际生活条件下对其进行量化铺平了道路。
